The assessment of ROTEM test in patients with critical form of COVID-19

ABSTRACT

Background: Patients with comorbidities could have severe COVID-19 outcomes. Thrombosis or hemorrhages were frequently reported during COVID-19 evolution Aims: The study evaluated the role of ROTEM in the identification of patients with a high risk of vascular complications Methods: We analyzed clinical, ROTEM, and laboratory data of 80 patients admitted to the intensive care unit (ICU) Department of our hospital, during 2020-2021. Result(s) Thrombosis was diagnosed in 26 cases (27.96%) and was more frequent in patients with severe pneumonia and ARDS, Chi-squared 3.55, p = 0.05. Hemorrhages were identified in 21 cases (22.58%) and were less frequent in patients with severe ARDS, Chi-squared = 4.67, p = 0.03. ROTEM analyses were focused on ExTEM, InTEM, and FibTEM clotting time (CT), clot amplitudes after five and ten minutes (A5/A10), maximum clot firmness (MCF), and maximum lysis (ML). In the ExTEM median CT (eCT) value was 90.5 (50-207) s in patients with severe ARDS vs 75(58-571) s in patients with mild/ medium ARDS, p = 0.02;A5 44 (16-68) in patient with thrombosis vs. 53 (12-69) in patient without thrombosis;ML 6 (0-104) in patients with sepsis vs 8 (0-15) in patient without sepsis, p = 0.04.The median FibTEM CT (fCT) was 91 (53-7913) s in patients with severe ARDS vs 76 (52-8203) s in patients with mild/medium ARDS, p = 0.009;there were a significant correlation with ferritin level, rho = 0.22, p = 0.05. An increasing value of fCT during COVID-19 evolution was observed especially in the critical form of COVID-19. Lymphopenia was significant in patient with severe ARDS 0.48 x 1000/uL (0.02-8.03) vs 0.67 x 1000/uL (0.14-9.09) identified in patients with mild/medium ARDS, p = 0.05;it was not obtained significant correlations between lab test and ROTEM results. Conclusion(s) The ROTEM test suggests showing hypercoagulability probably due to severe inflammation. Patients with a critical form of COVID-19 developed thrombotic complications more frequently than hemorrhages. We have to check these results in large cohorts of patients.